The gold standard treatment for convergence insufficiency

Convergence insufficiency (CI) patients are unable to properly make their eyes move inward when doing near work like reading. Often, the intensity of symptoms in CI depends on the amount and type of near work a patient does.  Students obviously do lots of near work their symptoms may be severe and diminish their academic performance.

The problem of CI is serious enough that the National Eye Institute (one of the National Institutes of Health in the United States) funded a number of studies to determine the best treatment for CI.  These studies are known as the Convergence Insufficiency Treatment Trials (CITT).  Most of the CITT studies can be found here.  The treatments investigated by the CITT included office-based accommodative–vergence therapy with supplemental home therapy, placebo office-based vision therapy, home-based computerized vision therapy with pencil push-ups, and pencil push-ups. 

A major review of the CI research to date was published in the journal Optometry earlier in 2012.  You can read the entire review here.

Patients who participated in the CITT were assessed at the end of 12 weeks of  therapy. In-office vision therapy supplemented with home therapy was found to be the most effective treatment. Long-term effects were determined at 6 months and 12 months of follow-up and the beneficial effects of vision therapy were found to be lasting.

Vision therapy is the gold standard for treating CI.

Fall 2012 eyewear trends

Here are the some of the Fall 2012 eyewear trends for men:

American Vintage

With influences from the ‘70s and true American style, frames this season will have men pining after these sporty, yet vintage-inspired frames. Wood detailing adds a natural vibe, while wayfarer shapes keep the geek chic trend alive and well. Retro aviators have also made their imprint on the runways, and are quintessential for any guy trying to emulate this look.

 Victorian Dandy

This fall, dandy details rule and men everywhere are taking note. Round frames - a la John Lennon - are a must for both optical and sun, whether in metal or plastic. Black, as well as classic and fresh takes on tortoise are key for this well-bred style, while keyhole bridges and browline frames add sophisticated, retro flair.

 For more visit  http://www.eyecessorize.com/trend.cfm?trend=60

Eye nutrition basics

Here is some clear and concise information on nutrition and eye health from the
American Optometric Association (www.aoa.org):

• Lutein & Zeaxanthin

  Lutein and zeaxanthin are important nutrients found in green leafy vegetables, as well as other foods, such as eggs. Many studies have shown that lutein and zeaxanthin reduce the risk of chronic eye diseases, including age-related macular degeneration and cataracts.

• Vitamin C

  Vitamin C (ascorbic acid) is an antioxidant found in fruits and vegetables. Scientific evidence suggests vitamin C lowers the risk of developing cataracts, and when taken in combination with other essential nutrients, can slow the progression of age-related macular degeneration and visual acuity loss.

• Vitamin E

  Vitamin E in its most biologically active form is a powerful antioxidant found in nuts, fortified cereals and sweet potatoes. It is thought to protect cells of the eyes from damage caused by unstable molecules called free radicals which break down healthy tissue.

• Essential Fatty Acids

  Fats are a necessary part of the human diet. They maintain the integrity of the nervous system, fuel cells and boost the immune system. Two omega-3 fatty acids have been shown to be important for proper visual development and retinal function.

• Zinc

  Zinc is an essential trace mineral or ‘helper molecule.’ It plays a vital role in bringing vitamin A from the liver to the retina in order to produce melanin, a protective pigment in the eyes. Zinc is highly concentrated in the eye, mostly in the retina and choroid, the vascular tissue layer lying under the retina.

• Emerging Research

  In the last 20 years, eye health research has linked diet and nutrition with a decreased risk of age-related macular degeneration (AMD).

Written in partnership with AOA members Stuart Richer, O.D., Ph.D., and Steven Newman, O.D.

To learn more about eye nutrition visit www.eyenutrition.ca.

Related articles:

Vitamin C lowers cataract risk

The miracle vitamin - vitamin D - gets more miraculous

Vegetarians and vegans have a lower risk of cataracts 

April is women's eye health and safety month - women must focus on eye nutrition

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Orthokeratology is shown to be safe for correcting myopia in children

A new study on orthokeratology was just published in the August 2012 issue of the journal Optometry & Vision Science.  The purpose of the study was to find the rate of adverse events associated with orthokeratology use in children over a two year period.

Orthokeratology is doctor-supervised vision correction where the patient wears a custom designed and manufactured lens retainer while they sleep.  The lens retainer reshapes the cornea of the eye allowing it to focus light properly for clear vision.   In the morning, the patient awakes to perfect vision during the day without glasses, contacts or surgery.

The study tracked 61 children from the ages of 6 to 12 with myopia and astigmatism.  The researchers checked in with the children every six months and told them to contact the clinic as soon as any adverse event occurs.  

The study authors concluded that the relatively low incidence of adverse events and discontinuations with orthokeratology is conducive for the correction of myopia in children with orthokeratology lens retainers.

This is the latest is number of new studies showing that orthokeratology is safe and effective.  Here are some others that we have written about:

• Orthokeratology is shown to be effective in correcting astigmatism. Patients with astigmatism now have an alternative to glasses, contact lenses and laser surgery

• New study supports orthokeratology for myopia control and for astigmatism correction

Mom of Struggling Reader Finds Help and Speaks Out for College of Optometrists in Vision Development's National Children's Vision and Learning Month

This blog post reproduces the content of a press release issued by the College of Optometrists in Vision Development to commemorate National Children's Vision Learning Month. It is a story that is familiar in my office and the office of every developmental optometrist. Patients are told by doctor after doctor that their child's vision is fine so long as the child can read the letters on the chart and there is nothing wrong with the physiology of the eye. However,visual acuity the the health of the structures that make up the eye are only part of an eye examination.

Developmental optometrists also assess the functioning and movement of the eye, the ocular muscles and the workings of the visual system. The latter assessments can uncover binocular vision problems or deficiencies in visual informaiton processing, which have been shown to adversely impact learning and academic performance.

Here is the press release:

Despite being told by five different eye doctors that her 8-year-old daughter Shelby's vision was fine, Lynn DeVore of Yakima, Washington continued to search for reasons why her daughter continued to struggle with reading. The pediatrician said that since the eye doctors said Shelby's vision was fine that Lynn "was just being paranoid and that maybe Shelby was simply not very smart." She continued to search until she found the answer and now DeVore is stepping forward to help other parents by sharing their story for National Children's Vision and Learning Month.

"We knew there was a problem early on, but we were told she would read soon. We struggled and struggled and still reading was a fight. Shelby was very frustrated with reading and had very little confidence in all areas of her life," shares DeVore. Fortunately she saw an ad in a local magazine that listed all the things Shelby struggled with. The ad was for a developmental optometrist who provides an in-office program of optometric vision therapy.

The evaluation confirmed that Shelby did in fact have a vision problem. It was convergence insufficiency, an eye coordination problem that can make reading very difficult. After completing the prescribed program of vision therapy, Shelby went from reading at 1st grade level to reading on grade level.

How could so many eye doctors have missed this? A very good question! When parents suspect their children have a vision problem that is contributing to their learning difficulties they often go to the pediatrician or the pediatric ophthalmologist only to be told their child's vision is fine and they can see 20/20. States Dr. David Damari, President of the College of Optometrists in Vision Development, "It is important for parents to know that when it comes to the diagnosis and treatment of vision problems which interfere with reading and learning, a comprehensive vision exam is needed. These children need to see an optometrist who provides an in-office program of vision therapy and performsthe in-depth testing required to determine if the child has all the visual skills required for academic success,".

Despite volumes of evidence-based optometric research, many pediatricians and ophthalmologists continue to state that vision has nothing to do with learning, referring parents to psychologists, learning specialists, etc. However, the limitations caused by convergence insufficiency and similar visual disorders can be disabling during reading and computer use according to the definitions of disability in the Americans with Disability Act, but these disorders are all easily treatable with optometric vision therapy.

The five most common signs that a vision problem may be interfering with your student's ability to read and learn are:

1. Skips lines, rereads lines

2. Poor reading comprehension

3. Takes much longer doing homework than it should take

4. Reverses letters like "b" into "d" when reading

5. Has a short attention span with reading and schoolwork

Any one of these symptoms is a sign of a possible vision problem. A more in-depth symptoms checklist is available on COVD's website.

It is vital that parents take the time to learn all of the signs that a vision problem may be interfering with academic performance. When a child has a vision problem, they do not outgrow it, and despite extensive tutoring or special services at school, very little improvement occurs.

Shelby was lucky that her mother didn't take no for an answer. Take 5 minutes in honor of August being National Children's Vision and Learning Month and visit the website for the College of Optometrists in Vision Development; then spread the word and share the information: www.covd.org .